The purpose of this investigation was to evaluate the immediate and clinically relevant information gained from the modified barium swallow study and to determine the impact of the procedure on patient management. A database containing a nonrandom sample of 608 swallowing studies was reviewed. Results showed that only 10.4% of the studies were classified as normal examinations and aspiration occurred in 32.4%. However, swallowing abnormality without aspiration was recorded in 57.2% of the studies. Five additional outcome variables were assessed: referrals made to other specialties, effectiveness of applied compensatory strategies, treatment recommendations, mode of intake change, and diet grade change. Nearly 83% of the 608 studies showed change in at least one of the variables: needed referral to a specialist was identified on 26.3%; compensatory strategies that improved swallow physiology were identified on 48.4%; swallowing therapy was recommended on 37.2%; changes in mode of intake occurred on 31.4%; and diet texture changes were recommended on 43.8%. The low percentage of normal studies coupled with the high percentage of change in measurable variables indicate high clinical utility for the modified barium swallow study. The misguided tendency to refer to the modified barium study only as a tool for identifying aspiration and the appropriate utilization of the examination for identification of underlying abnormality in swallowing physiology are explained.